Rajiv Gandhi University of Health Sciences, Bangalore
M.D.S, Pedodontics & Preventive Dentistry
Synopsis for Registration of Dissertation
M.R. Ambedkar Dental College& Hospital
# 1/36, Cline Road, Cooke Town
\ Bangalore -05.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. Name of candidate and Dr. UDHYA.J
Address DEPARTMENT OF PEDODONTICS AND
M.R. AMBEDKAR DENTAL COLLEGE AND
M.R. AMBEDKAR DENTAL COLLEGE AND
2. Name of the Institution
NO 1/36 CLINE ROAD, COOKE TOWN,
3.Course of study and M.D.S PEDODONTICS AND PREVENTIVE
4.Date of admission to 30/04/2010
5. Title of topic COMPARATIVE CLINICAL EVALUATION OF TENS OVER
CONVENTIONAL LOCAL ANESTHESIA IN CHILDREN FOR
6. Brief resume of intended work :
6.1 Need for study :
One of the most distressing aspects of dentistry is the fear and anxiety caused by
dental environment particularly to dental injections referred to as ‘Needle Phobia or
Blenophobia’. Reducing this fear and anxiety in children may help the pediatric dentist to
provide an overall comfort and well being during the entire dental procedure. One of the
substantial alternatives for the conventional local anesthesia is the Transcutaneous Electrical
Nerve Stimulation (Tens) the concept is not new; it has long and fascinating history, dating
back to the year 46 A.D. when scribonius Largus claimed to cure head ache and arthritis
through application of the electric torpedo fish1. Case reports of pain control through the
application of electric current in dentistry exist from the year 17702.The use of electricity as a
means of pain management and as a curative agent flourished well into the nineteenth century
in Europe and the United States.3 Inexplicably, the medical and dental use of electricity began
to wane in the early 1900s. Dentistry has recently seen a rekindling of interest in this area.
The technique applied in dentistry is termed “electronic dental anesthesia ’’ or EDA4. In order
to provide feasible alternative in dentist pain control armentarium the present study is
intended to clinically evaluate the effectiveness of TENS as compared to Local Anesthesia.
The primary aim of the present study is to assess the effectiveness of pain control by
employing TENS over conventional local anesthesia for children requiring restorative
procedures under rubber dam.
6.2 Review of Literature :
The effect of peripheral electrical stimulation on tooth pain threshold and comfort of
oral soft tissue was evaluated in 30 children, using a double-blind, crossover, study design. In
their study the electrical stimulation significantly increased tooth pain threshold and reduced
the cardiovascular stress response without altering comfort levels during placement of rubber
A study was conducted to examine the use of TENS alone and TENS combined with
N2O for restorative procedures without local anesthesia to 371 adult patients. in their they
suggest that the combination of TENS/N2O may be a more effective strategy for many
patients than TENS alone6
The primary aim of the investigation was to determine if EDA is effective in
providing pain control adequate to permit the completion of routine restorative dentistry, in
their present study, EDA appears to be a pain control technique with a promising future. EDA
does offer a very viable alternative in those situations in which local anesthesia are either
contraindicated or prove ineffective7
The purpose of this study was to evaluate the effectiveness of Transcutaneous
Electrical Nerve Stimulation (TENS) in pain reduction during cavity preparations in pediatric
patients. Twenty patients, ages eight to fourteen years, were treated for Class I amalgam
restorations in mandibular first permanent molars using TENS in a double blind protocol.
There was a statistically significant decrease in the pain perceptions of pediatric patients
during Class I amalgam cavity preparations in mandibular first permanent molars8.
The purpose of this study was to evaluate the effectiveness of a transcutaneous
electrical nerve stimulation unit. The effects of electronic dental anesthesia and local
anesthesia for deep cavity preparations in primary molars were compared in children aged 7
to 9 years by using the Eland Color Scale. The patients had symmetric teeth requiring Class I
cavity preparation. One of the teeth was treated with electronic anesthesia and the other with
local anesthesia. The tooth and method were selected randomly. Both restorations were
finished at the same visit. There was no statistically significant difference between the groups
in the perception of pain. Fifty-six percent of the children preferred transcutaneous electric
The effectiveness of electronic dental anesthesia (EDA) for pain control during
restorative procedure was compared with local anesthetic injection (LA) in 32 children aged 6
to 12years. Each child selected had two antimere primary or permanent molars requiring
similar-sized Class I or Class II restorations. The pain levels during restorative treatment were
assessed using a visual analogue scale. Heart rates and behavior were also recorded.
Crossover design was used with each child acting as his/her own control. The results showed
that overall; EDA was less effective than LA for cavity preparation. The reported pain scores
for EDA were higher in permanent teeth for the deeper cavities, and with one of the operators.
The pre- or post-treatment anxiety scores were not found to differ significantly between the
two restorative appointments. However children with the highest pretreatment scores were
more likely to report higher pain scores with EDA. Despite this, 63% of the children preferred
EDAto LA.Dental anxiety, cavity depth, the tooth being treated, and operator attitude may
also be important factors in determining the success of EDA 10
The purpose of this study was to determine the effectiveness and acceptance of
electronic dental anesthesia in comparison with local anesthesia in restorative procedures in
children. Twenty-eight children, aged 6 to 12 years, participated in the study. Each patient
had symmetric teeth requiring class I cavity preparations. One tooth was treated with
electronic dental anesthesia; the antimere tooth was treated with local anesthesia. The tooth
and the method were selected at random, and the two restorations were performed at the same
appointment. Pain was assessed by means of two pain scales, the color scale and the sound,
eye, and motor scale. Behavior was assessed through use of the North Carolina Behavior
Rating Scale. The ratings of pain and behavior were made at 4 separate intervals (after rubber
dam clamp placement, with the handpiece operating adjacent to the tooth, during penetration
of the dentin-enamel junction of the tooth, and 5 minutes postoperatively). Although the
success rate of electronic dental anesthesia was less than that of local anesthesia, there was no
significant difference between the two methods. On the other hand, 53.6% of the patients
preferred electronic dental anesthesia, whereas 35.7% preferred local anesthesia11.
6.3 Objectives of the study:
To assess the effectiveness of pain control by employing TENS over conventional
local anesthesia for children requiring restorative procedures under rubber dam.
7.1 Source of data:
The study population will consist of 30 (15males and 15 females) subjects under the age
group of 6-12 years. The patient attending the Dept of Pedodontics & Preventive Dentistry,
M.R.Ambedkar Dental College & Hospital, Bangalore, will be selected randomly. The entire
procedure & need for the study will be explained to the subjects and parents or local guardian,
and written informed consent (annexure 1) will be taken from the parents or local guardian.
1. Patients under the age group of 6-12 years
2. Never exposed to TENS.
3. Subjects presenting with stained fissures w.r.t lower right & left first molar requiring
pit & fissure sealants.
4. Volunteered & agreed
1. Immaturity (Inability to understand the concept of patient control of pain) such as
a. Very young pediatric patient
b. Physically or mentally disabled children
2. Neurological disorders such as
a. History of epilepsy
b. History of transient ischemic attacks
c. Status post – Cerebrovascular accidents(stroke)
7.2 Methods of collection of data:
At the start of the experiment, baseline values of pain threshold for both right
&left first permanent molar will be obtained using the electric pulp tester. Each tooth will be
isolated and dried thoroughly prior to testing. The subject will be told to raise his/her hand
when the stimulus became painful. At that time, the investigator removed the probe; the
reading from the pulp tester will be recorded by a dental assistant. After obtaining the base
line values of the pain threshold for the molars, the pulse oximeter will be fitted to the subject
finger to record the heart rate.
For standardization, the rubber dam placement and sealant application on right side
(Test side) will be performed under TENS and on the left side(control side) will be
performed under LA.
Test Side (Under Tens):
The site of electrode pad should be gently swabbed with surgical spirit to remove any
skin oils or substances that may interfere with current flow. Electrode gel will be applied on
the electrode pad before placement. The patient will be instructed to open the mouth wide as
done during the treatment and then the electrode pad was secured in place using surgical tape
to minimize displacement. The system will be switched on, and the investigator controlled the
level of electronic anesthesia by gradually raising the amplitude dial until the patient felt a
significant sensation. for the patient to acclimatize to the new sensation of electronic
anesthesia, this amplitude level should be maintained for an initial duration of 20 sec. The
amplitude is then raised to the next level and the cycle was repeated, until fasciculation is
noted on lower lip in case of mandibular arch. Muscle fasciculation is the sign of reaching the
‘minimal therapeutic level’ at which the procedure can began. The pain threshold of the teeth
using EPT & the heart rate using pulse oximeter of the subject should be recorded after
stimulation is began, then the rubber dam will be placed and the sealant application will be
carried out. The subject will be instructed to indicate the level of comfort or discomfort felt
by using a visual analog scale (V.A.S)
Control Side(Under LA):
On the left side, local anesthesia will be administered (infiltration), pain threshold &
heart rate of the subject will be recorded. Then the rubber dam will be placed & sealant
application will be carried out. The subject will be instructed to indicate the level of comfort
or discomfort on an visual analog scale(V.A.S)
Statistical analysis: All the values will be subjected for statistical analysis
Duration of study: The study will be carried out from March2011 to Aug 2012.
7.3 Does the study require any investigations to be conducted on patients or other
human or animals?
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
8. List of Reference:
1.scribonius Largus : De compositone medicamentorum.Liber, CLXII
2. Ferguson J: An introduction to electricity. London, 1770.
3. Erb W: Handbook of electrotherapeutics. New York.W.Wood&Co.1883
4. Malamed S et al. Electronic Dental Anesthesia for restorative dentistry. Anesth Prog
1989; 36: 192-200.
5.Abdulhameed SM , Feigal RJ, Joel RD, Keith CK. Effect of peripheral electrical
stimulation on measures of tooth pain threshold and oral soft tissue comfort in children .
Anesth Prog 1989 ; 36: 52-57.
6. Quarnstrom FC, Milgrom P . Clinical experience with TENS & TENS combined
with Nitrous Oxide – Oxygen.Anesth Prog 1989; 36:66-69.
7. Malamed SF, Quinn CL, Torgersen RT, Thompson W. Electronic dental anesthesia
for restorative dentistry. Anesth Prog 1989; 36:192-200
8. Harvey M, Elliott M. Transcutaneous electrical nerve stimulation (TENS) for pain
management during cavity preparations in pediatric patients.ASDC J Dent Child. 1995
9. Oztaş N, Olmez A, Yel B.Clinical evaluation of transcutaneous electronic nerve
stimulation for pain control during tooth preparation. Quintessence Int. 1997;28(9):603-8
10.Shigu YU, Drummond BK, Anderson MH, Williams S. Effectiveness of electronic
dental anesthesia restorative care in children. Pediatr Dent 1998;20: 2105-111,
11.Ziad D. Baghdadi DDS, MS. Evaluation of electronic dental anesthesia in children
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology
SIGNATURE OF THE CANDIDATE
REMARKS OF THE GUIDE This study is under my guidance and supervision
NAME AND DESIGNATION OF DR. ILA SRINIVASAN
THE GUIDE PROFESSOR AND HEAD,
DEPARTMENT OF PEDODONTICS AND PREVENTIVE
DENTISTRY,M.R. AMBEDKAR DENTAL COLLEGE,
SIGNATURE OF THE GUIDE
CO-GUIDE Dr. KAYAL VIZHI .G ,
DEPARTMENT OF PEDODONTICS AND PREVENTIVE
DENTISTRY, M.R. AMBEDKAR DENTAL COLLEGE,
HEAD OF THE DEPARTMENT DR. ILA SRINIVASAN
REMARK OF THE PRINCIPAL